Three Part Question

Clinical Scenario

A one year old girl presents to the Emergency Department with acute wheeze and suspected asthma. Her GP had given her salbutamol syrup which did not appear to help. You use salbutamol via a spacer and want to know if oral bronchodilators are effective at relieving asthma symptoms.

Search Strategy

PubMed. Similar searches were conducted for: Embase, Google Scholar, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Australian New Zealand Clinical Trials Registry, and ClinicalTrials.gov
[oral OR liquid OR syrup OR elixir] AND [inhaled or aerosol] AND [salbutamol OR albuterol OR ventolin OR terbutaline OR bricanyl OR beta 2 agonist] AND asthma AND [child* OR pediatric OR paediatric] LiIMIT to Humans and Clinical Trial or Randomised Controlled Trial and All Child: 0-18 years

Search Outcome

14 papers were identified; six were relevant comparisons of oral and inhaled salbutamol use in the treatment of asthma in children less than 18 years of age.

Reported for 5 of 11 patients treated with oral salbutamol, and for 1 of 13 patients treated with inhaled salbutamol (P = 0.06)

Small study population. Steroid use not controlled between treatment groups (4/11 patients treated with oral salbutamol were administered steroids; 0/13 patients treated with aerosol salbutamol received steroids, P < 0.01). Complete data was only available for 22 patients (telephone follow-up data was available for 2 patients, no follow-up data was available for 10 patients)

Comment(s)

None of the found studies demonstrated benefit. We also searched for Terbutaline studies and none were found. One study was identified of oral and inhaled salbutamol use in the prevention of exercise-induced asthma in children. A review of the pharmacokinetics of salbutamol syrup suggests that oral administration is very unlikely to be effective. (1).
1. Boulton DW, Fawcett JP. Pharmacokinetics and pharmacodynamics of single oral doses of albuterol and its enantiomers in humans. Clin Pharmacol Ther. 1997 Aug.;62(2):138–144.

Clinical Bottom Line

Oral salbutamol is ineffective in the treatment of paediatric asthma and is associated with an increased incidence of adverse events compared with inhaled formulations. Paediatric masks and spacers can facilitate administration of inhaled salbutamol to all patients; therefore, there is no role for oral salbutamol. Oral salbutamol should be excluded from use in the treatment of childhood asthma.

References

Scalabrin DMF, Naspitz CK Efficacy and Side Effects of Salbutamol in Acute Asthma in Children: Comparison of Oral Route and Two Different Nebulizer Systems J Asthma 1993; 30(1): 51-59